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CGM

Concerns About Glycemic Control Among Youth and Young Adults with Type 1 Diabetes

Glycemic Control Among Youth with Type 1 Diabetes

Scientists have come a long way in their understanding of type 1 diabetes and in not only treatments used to manage the disease, but also technology. From continuous glucose monitors and insulin pumps to smart apps, there is a lot of diabetic technology that exists to support patients. But that does not mean that all patients are taking advantage of it or necessarily have access.

In a recent study by SEARCH, individuals with type 1 diabetes between the ages of 10 and 24 showed poorer levels of glycemic control between 2014 and 2019 than the study cohort from 2002 to 2007, despite improvements in treatment and management options. The SEARCH study encompasses more than 20,000 participants from sites in California, Colorado, Ohio, South Carolina, and Washington.

This particular study evaluated data from 6,492 participants and divided them into cohorts from 2002 to 2007, 2008 to 2013, and 2014 to 2019. Information was also categorized based on the duration of diabetes and whether the participant had type 1 diabetes or type 2 diabetes, with the majority of participants having type 1. Researchers then analyzed HbA1c levels over time, adjusting data for “site, age, sex, race, health insurance status and disease duration, both overall and for each duration group.”

Although average HbA1c levels remained consistent across cohorts (8.7% for 2014-2019, 8.9% for 2008-2013, and 8.6% for 2002-2007), when broken down by individual age ranges, those between the ages of 10 and 24 had poorer glycemic control in 2014-2019 than in 2002-2007.

These findings highlight the need for improved access to and use of diabetic technology as well as other interventions to support youth and young adults in enhancing glycemic control. Maintaining tight glycemic control and staying within target ranges can help reduce potential complications from the disease and promote better health.

Diabetes Research Connection (DRC) is committed to advancing research related to T1D and improving prevention, treatment, and management efforts as well as one day finding a cure. Early-career scientists can receive up to $50K in funding to support their peer-reviewed, novel research studies. Learn more about current projects and how to donate by visiting https://diabetesresearchconnection.org.

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Scientist

Reducing the Need for Systemic Immunosuppression for Islet Grafts

Immunosuppression for Islet Grafts

One of the approaches scientists have been testing for reversing or better controlling type 1 diabetes is the use of allogeneic pancreatic islet transplants. By reintroducing healthy insulin-producing islets, they aim to support the body in naturally regulating and stimulating insulin production to manage blood glucose levels.

A major challenge to this technique, however, is the immune system’s rejection of the graft following transplantation. As with organ transplants, scientists were forced to suppress the immune response in order to keep cells from attacking and destroying the islets. But immunosuppression is not a long-term solution for islet graft transplantation because the potential risks and health effects can outweigh the benefits.

In a recent study, scientists explored the possibility of controlling a localized immune response rather than a systemic one. They designed a synthetic platform that contains microgel made of biomaterials that can deliver checkpoint proteins to regulate cell death.  They used a chemeric streptavidin/programmed cell death-1 (SA-PD-L1) protein. In addition to this protein, they added a short, two-week administration of rapamycin to help the body adjust to the transplant while curbing rejection risk. This approach enabled the sustained survival of allogeneic islet grafts without the need for chronic systemic immunosuppression.

These results demonstrate the potential benefits of using synthetic microgels in combination with immunomodulatory ligands and specific antibodies to manage the immune response to allogeneic pancreatic islet grafts. While additional research is needed, this is a step toward improving therapeutic modalities for treating or potentially reversing type 1 diabetes.

The Diabetes Research Connection (DRC) is interested to see how this study influences future work on islet transplantation as an option for managing type 1 diabetes. The DRC is committed to advancing research within the field by providing critical funding to early-career scientists pursuing novel research studies focused on all aspects of type 1 diabetes. Learn more about current projects and how to help by visiting https://diabetesresearchconnection.org.

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CGM Use In Hospitals

Reducing COVID-19 Deaths and Other Complications for Patients Hospitalized with Diabetes

CGM Use In Hospitals

Covid-19 patients who have diabetes experience a higher mortality rate than the general population. A new protocol incorporates the use of continuous glucose monitors (CGM) to track and manage hospital patients’ blood glucose (BG) levels before problems arise. Monitoring and treating glucose levels is critical for patients with diabetes.

 

A clinical study conducted by Scripps Whittier Diabetes Institute (SWDI),  Glucose as the Fifth Vital Sign:  A Randomized Controlled Trial of Continuous Glucose Monitoring in a Non-ICU Setting, was led by the Scripps Whittier Diabetes Institute’s (SWDI) Addie Fortmann, Ph.D. with support from the Diabetes Research Connection (DRC).  The use of CGM in hospitals has the potential to enhance care, reduce the length of stays, and yield improved outcomes, as well as greater patient satisfaction. “The current pandemic environment has greatly accelerated the need to find safe and effective ways to monitor the blood sugar of hospitalized patients without interfering with the necessary and often intensive interventions to treat COVID-19,” said Addie Fortmann, Ph.D., director of the diabetes service line at Scripps and the lead author of the paper. “Our study clearly demonstrates the value of CGM in community hospitals, and it offers a model for other health systems that are looking to use this technology in similar ways.”

 

“DRC’s funding helped to enable Scripps to evaluate effects of CGM in a hospital in a study setting and use the experience to expedite deployment of this important glucose monitoring system when the FDA provided emergency use authorization (EUA) in March of this year,” according to Dr. Alberto Hayek, Scientific Advisor at SWDI, endocrinologist, former T1D researcher at SWDI and UCSD, and President and co-founder of DRC. When individuals are hospitalized, diabetes management is more difficult. Not only are patients dealing with the condition which brought them to the hospital, their blood sugar levels must be continuously monitored, which is very difficult if the patient is on a ventilator or is unconscious.

 

The U.K. National Health Service (NHS) recently published research concluded hospitalized individuals with type 1 diabetes (T1D) are significantly more likely to die from COVID-19 than those with type 2 diabetes (T2D). Preliminary findings, recently published in Diabetes Care, determined a third of people with T1D and COVID-19 in the U.S. experienced diabetic ketoacidosis, from elevated BG, and half experienced hypoglycemia (low BG). Both of these serious conditions can lead to death. Individuals with T1D typically do not produce insulin which presents serious challenges to managing inpatient BG.

 

“Tracking vital signs is routine in many hospitalized patients,” said Athena Philis-Tsimikas, M.D., corporate vice president of Scripps Whittier and the senior author of the report. “This study demonstrates that blood sugar should be considered the fifth vital sign for hospitalized diabetes patients, joining temperature, pulse, respiration and blood pressure, as a potentially crucial metric for delivering the highest quality care.”

A CGM uses a small sensor that is inserted under the skin. It sends a glucose reading via Bluetooth every five minutes to hospital staff so that they can track glucose levels and receive alerts when levels start to rise or fall out of the target range.

 

David Winkler, co-founder of DRC, Chair of the Board, has been living with this autoimmune disease for more than 60 years. He has experienced several challenging hospital stays himself and said, “I strongly endorse Scripps’ exciting new CGM protocol to lessen the serious concerns T1Ds experience in the hospital environment. I applaud Scripps for this material paradigm shift.”

 

The DRC is excited to see how this clinical research will influence hospital protocols nationally to provide enhanced care for patients with diabetes by better managing their blood glucose levels during a hospital stay.

 

Dr. Hayek added, “Our non-profit funds novel T1D research nationally. DRC’s 80 member Scientific Review Committee peer-reviews all grants, including this breakthrough clinical trial.”

 

To learn more about the T1D research projects supported by DRC and how this charity provides hope for treatment and cure of this disease, please visit https://DiabetesResearchConnection.org.

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analyzing Beta-Cells

Advances in Maintaining Beta-Cell Function in Relation to Type 1 Diabetes

Maintaining Beta-Cell Function with T1D

In healthy individuals, pancreatic beta cells respond to glucose levels in the blood and automatically increase or decrease the production and release of insulin. This occurs without individuals ever knowing it happened. But in those with type 1 diabetes (T1D), the immune system mistakenly attacks and destroys insulin-producing beta cells leaving the body unable to naturally regulate blood sugar levels. Instead, individuals must do this on their own by continually monitoring their blood sugar and administering the appropriate amount of insulin via injection or an insulin pump.

However, in the early stages of type 1 diabetes, the pancreas continues to produce insulin, just not enough to keep blood sugar entirely under control. Eventually, this function ceases and individuals become insulin-dependent. Researchers have been investigating potential treatment options to preserve beta-cell function and slow the progression of type 1 diabetes.

A recent study found that the drug golimumab has shown positive results when used to treat individuals newly diagnosed with T1D. When administered every two weeks, this anti-tumor-necrosis-factor (TNF) therapy helped preserve beta-cell function and reduced the amount of additional insulin required by patients.

After 52 weeks of treatment, “41.1% of participants receiving golimumab had an increase or less than 5% decrease in C-peptide compared to only 10.7% in the placebo group.” C-peptide only measures the amount of insulin produced naturally by the pancreas, not injected insulin. Participants receiving the drug were able to maintain better blood sugar control with less insulin and also experienced a decrease in incidences of hypoglycemia where blood sugar was less than 54 mg/dL.

Another treatment that has shown potential is the combination of anti-interleukin (IL)-21 and liraglutide. Participants were randomly assigned to one of four groups: anti-IL-21, liraglutide, anti-IL-21 and liraglutide, or a placebo. Anti-IL-21 targets IL-21-mediated inflammation while liraglutide may reduce cell stress and apoptotic cell death. Treatment was administered every six weeks for 54 weeks.

At the end of the trial, those participants who received the combination treatment showed statistically better beta-cell function than those receiving only liraglutide or the placebo. Beta-cell function was nonsignificant when compared to those receiving only anti-IL-21. In addition, results showed that “combination therapy resulted in the lowest on-treatment glucose levels, although this was not statistically significant, and a significant 32% reduction in insulin dose relative to placebo.”

A third treatment of note was the use of ladarixin, a CXCR1/2 inhibitor that blocks IL-8. Although this therapy did not slow beta-cell function decline during the three-month trial period, it did achieve a statistically significant decline after six months. However, these effects had disappeared again by 12 months. But individuals taking ladarixin did experience better HbA1c levels than those in the placebo group. More research is needed on potential uses and effectiveness of ladarixin.

In addition, researchers also conducted a study involving individuals who were not yet diagnosed with T1D, but who were at high risk due to family history and the presence of at least two autoantibodies. They wanted to see if they could preserve beta-cell function and delay onset of T1D through the use of an Fc receptor-nonbinding anti-CD3 monoclonal antibody called teplizumab.

In this trial, 44 participants received teplizumab, and 32 received a placebo. Treatment was administered for 14 days. The results showed that “the medium time to the diagnosis of type 1 diabetes was 48.4 months in the teplizumab group and 24.4 months in the placebo group.” Overall, T1D was eventually diagnosed in 43% of the teplizumab group and 72% of the placebo group, demonstrating that the treatment may have helped slow the progression of the disease and preserve beta-cell function in individuals at high risk of developing T1D.

All of these therapies are continuing to undergo research to determine their effectiveness and potential use in delaying or preventing the onset of T1D. Diabetes Research Connection (DRC) is dedicated to ensuring that this type of work continues and provides critical funding to early-career scientists pursuing novel, peer-reviewed studies related to type 1 diabetes. Dr. Kevan Herold, a Yale researcher and member of the DRC’s scientific review committee (SRC), was involved in the study regarding teplizumab. Learn more about how the DRC supports scientists and current research projects by visiting https://diabetesresearchconnection.org.

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CGM's

Evaluating the Benefits of Continuous Glucose Monitor Use

Benefits of CGM Use

Individuals with type 1 diabetes (T1D) have multiple options for managing their blood sugar, ranging from traditional finger sticks and insulin injections to continuous glucose monitors (CGM) and insulin pumps. Scientists are also continuing to work on more advanced technology including artificial pancreas systems.

CGMs are a popular device for individuals with T1D because they automatically measure and track blood glucose levels and send alerts when they begin to rise or fall too far. They tend to be worn most often by young children and adults ages 26 to 50. However, there are barriers to access for these devices including eligibility requirements and insurance coverage. Furthermore, not all primary care providers are well-versed in how to effectively manage care using these systems.

But recent studies show that CGMs may be especially beneficial for the groups that tend to wear them the least – teens and young adults, and older adults. When these devices are consistently used, they can help to improve glycemic control and reduce instances of hypoglycemia. These factors are essential for continued well-being.

One study followed a group of 153 adolescents and young adults between the ages of 14 and 24 for 26 weeks, then followed up at one year. All of the participants had HbA1c levels of at least 7.5% but not more than 11.0%. The control group contained 79 individuals who did not wear a CGM and conducted finger sticks four times per day to measure their blood glucose levels. The test group contained 74 individuals who wore a CGM and conducted finger sticks twice per day.

At the end of 26 weeks, HbA1c levels for the CGM group dropped from 8.9% to 8.5%, while levels for the control group remained steady at 8.9% throughout. In addition, the CGM group’s time in target glucose range increased from 9 hours per day to 10.3 hours per day, whereas the control group actually dropped from 8.7 hours per day to 8.3 hours per day. However, over time, the CGM group wore their devices less frequently, going from 82% to 68% of participants wearing the device at least five days per week.

At the end of one year, the results remained relatively consistent. Within the CGM group, HbAc1 levels improved slightly from 8.5% to 8.3%, while time in target range decreased slightly from 43% to 41%. There was a noticeable difference when it came to low blood sugar, with the average time spent below 70 mg/dL improving from 49 minutes per day to just 16 minutes per day.

On the other end of the spectrum, adults ages 60 and older also saw positive results when it came to CGM use. This study involved 203 adults split into the same type of test and control groups as the adolescents/young adults. The older adults in the CGM group were more consistent with their device use with 81% wearing it continuously and 89% wearing it at least five days per week.

The focus of this study was on hypoglycemia and time spent with a glucose level below 70 mg/dL. After 26 weeks, the CGM group went from 73 minutes per day to just 39 minutes per day, while the control group saw very minimal change. These rates stayed approximately the same at the one-year mark. In addition, the CGM group spent an average of 2.1 hours per day more in the target blood glucose range than the control group at 26 weeks.

The findings from both studies are encouraging when it comes to helping individuals with T1D to better manage their blood sugar and reduce the risk of hypoglycemia. It is important to educate patients on the benefits of using a CGM while also working to reduce barriers and improve access to this technology.

Though not involved in these studies, the Diabetes Research Connection supports early-career scientists in conducting research related to preventing and curing type 1 diabetes, minimizing complications, and improving quality of life for those living with the disease. From an increasing understanding of how and why the disease develops to improving treatment and management options, scientists are working hard every day. Learn more about current projects funded by the DRC and how to support these efforts by visiting http://diabetesresearchconnection.org.

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Researcher looking at a new T1D drug

New Drug May Delay Onset of Type 1 Diabetes

In many patients, there is a slight delay between the time when type 1 diabetes (T1D) is first diagnosed, and when they become dependent on insulin. This is known as the “honeymoon phase” and often lasts for a few months or up to a year. During this time, insulin-producing beta cells continue to function relatively normally and are supported by a small amount of insulin. Over time, these cells stop functioning and patients become insulin-dependent.

A recent study reveals that scientists have developed a breakthrough drug that may delay the onset of clinical T1D by up to three years. The drug, teplizumab, was used to treat patients who were identified at high risk of developing T1D due to the presence of at least two autoantibodies. The drug was administered for two weeks, and following this treatment, insulin secretion rates and C-peptide levels remained higher than for those participants who received a placebo.

During the preliminary trial, patients who took teplizumab showed a delayed onset of T1D of two years, but during the latest phase 2 drug trial, this was extended to three years. Participants who took a placebo continued to experience decreased insulin and C-peptide production as the disease progressed. As a result of these findings, the drug was awarded Breakthrough Therapy Designation by the U.S. Food and Drug Administration (FDA) and PRIority MEdicines (PRIME) Designation by the European Medicines Agency (EMA) in 2019.

More than 18 million people around the world are living with type 1 diabetes, and this drug has the potential to make a positive difference in the lives of millions more who are at-risk for the disease. Diabetes Research Connection (DRC) is excited to see how clinical trials continue to progress for teplizumab and whether it eventually becomes an approved prevention therapy for type 1 diabetes.

The DRC is committed to growing understanding and improving treatment and prevention of type 1 diabetes through providing critical funding for early-career scientists so they can advance and execute their research. Learn more about current projects and how to help by visiting https://diabetesresearchconnection.org.

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COVID-19

Managing Type 1 Diabetes and COVID-19

Type 1 Diabetes and COVID-19

As cases of COVID-19 continue to spread across the United States and the globe, scientists are especially interested in how it affects specific populations, such as those with type 1 diabetes (T1D). T1D is considered an underlying health condition and already puts individuals at greater risk when it comes to illness and potential complications.

One positive sign is that preliminary data from a recent study shows that many patients with T1D who also test positive for COVID-19 or have COVID-19-like symptoms are able to effectively manage their recovery at home. Less than 25% of patients were serious enough to require hospital admission. In addition, there were only two reported fatalities, and those individuals had existing comorbidities.

According to the preliminary data, it appears as though patients who have higher A1c levels and poorer glycemic management tend to be more negatively impacted by the disease. In addition, higher body mass index may also be a risk factor. When it comes to age, about 65% of cases were in individuals aged 18 or younger (though many had COVID-19-like symptoms, not confirmed diagnoses), and the average age of all 64 participants was 20.9 years. This is not an issue that is only facing older adults.

According to the study, “Overall, 34.9% of patients were able to manage COVID-19 entirely at home, with 27.3% of the confirmed and 43.3% of the suspected cases able to do so. At the other extreme, 22.2% of patients overall were admitted to the intensive care unit; 30.3% of the confirmed versus 13.3% of suspected cases.” Other patients were seen at an urgent care or hospital but not admitted.

Of those who managed their recovery at home, many received support virtually through telemedicine where they able to consult with endocrinologists and infectious disease specialists. There were also many who did not need to seek care and had their symptoms improve.

Since the initial study was conducted, more patient data has been submitted, and there are now 220 patients as opposed to 64. This data is still being analyzed and reviewed, but at first glance, researchers have found that results continue to be similar to the original group. Researchers are looking at A1c levels, glycemic management, comorbidities, mortality, telemedicine access and use, and more to better understand how COVID-19 is impacting individuals with T1D. They are also digging deeper into risk factors. A new paper reflecting this latest data is in the works.

There are still a lot of unknowns when it comes to COVID-19, but researchers are striving to understand how it may affect more vulnerable populations such as those with type 1 diabetes. The Diabetes Research Connection (DRC) continues to follow these studies and trends to stay up-to-date on the latest information. In addition, the DRC provides critical funding for early career scientists to conduct their own novel, peer-reviewed studies around T1D, whether related to COVID-19 or any other facet of the disease. To learn more and support current projects, visit http://diabetesresearchconnection.org.

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Costs of Diabetes

Exploring the High Costs of Diabetes Management

High Costs of Diabetes

Discussions around type 1 diabetes care and affordability often focus on the cost of insulin. While insulin prices can be extremely high and add up quickly depending on how much is needed to effectively control blood sugar levels and what is covered by insurance, this is not the only diabetes-related expense that individuals incur.

Insulin is only one part of managing diabetes. Patients also must pay for the supplies necessary to test and monitor their blood glucose levels and to administer insulin. Many people use continuous glucose monitors and insulin pumps to assist, and even if they don’t, they need syringes and other testing supplies.

A national study of 65,199 patients between the ages of 1 and 64 who had private, employer-sponsored insurance coverage found that the average out-of-pocket cost for managing diabetes was $2,500 a year. But only 18% of that cost was insulin. The rest was other supplies like those aforementioned. Furthermore, families with children who had type 1 diabetes were more likely to use CGMs and insulin pumps to help manage their child’s condition, and their annual out-of-pocket costs exceeded those of adults at $823 versus $445 respectively.

While steps have been taken to reduce the cost of insulin in recent years, and especially during the coronavirus pandemic, not as much has been done to improve the affordability and access of other diabetes-related supplies. CGMs and insulin pumps can play an integral role in helping patients better manage their diabetes and reduce complications, especially for children; in turn, this may help decrease additional medical expenses.

More focus is needed on the overall costs of diabetes management and how to better support patients in affording the care they need for improved health. The Diabetes Research Connection (DRC) stays abreast of the latest changes in the industry and advancements in research and treatment to help individuals with type 1 diabetes. Scientists are always working on ways to improve care and reduce the burden of the disease, and the DRC provides critical funding for these efforts. Learn more about current projects and how to support early-career scientists by visiting https://diabetesresearchconnection.org.

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COVID-19 testing

COVID-19 Symptoms in Individuals with Type 1 Diabetes

COVID-19 Testing

COVID-19 has taken our country by storm, and it is affecting individuals of all ages. No one is immune, and unfortunately, individuals with underlying health conditions tend to be at higher risk for complications. People with type 1 diabetes are already more severely affected by infections than individuals without the disease, and therefore they may be at higher risk for contracting COVID-19 and having poorer health outcomes.

A recent study looked at a group of 64 people with type 1 diabetes, 33 of whom had confirmed cases of COVID-19, and 31 of whom had COVID-19-like symptoms but no confirmed diagnosis. The median HbA1c levels were 8.5% and 8% respectively, and the average age was 24.8 years in the confirmed COVID-19 group and 16.8 years in the COVID-19-like symptom group.

Participants were part of a T1D Exchange Quality Improvement Collaborative (T1DX-QI) study and completed a 33-item questionnaire about their health and symptoms. They all had one or more symptoms that aligned with the Centers for Disease Control and Prevention’s (CDC) symptom profile for COVID-19.

The results showed that for both groups, high blood glucose, fever, and dry cough were the top three symptoms. Diabetic ketoacidosis (DKA) was reported in 45.5% of participants who tested positive for COVID-19 and 13.3% of those with COVID-19-like symptoms. This was a small study using data collected up to May 5, 2020. Additional research is needed to better track results as more is learned about the disease and its impact on individuals with type 1 diabetes. Also, since the average age of participants was teenagers and young adults and type 1 diabetes tends to develop in childhood, conducting pediatrics studies could also be beneficial to learn more.

As researchers continue to study COVID-19 and individuals with type 1 diabetes, they can better understand risk factors, complications, and therapeutic treatment options to deal with this novel coronavirus. The Diabetes Research Connection (DRC) is an organization dedicated to funding research around type 1 diabetes and will continue to stay abreast of the latest findings in regard to T1D and COVID-19. To learn more about the work conducted through the DRC and support these efforts, visit http://diabetesresearchconnection.org.

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insulin-producing

Protecting Insulin-Producing Islets Through Cell Editing

Protecting Insulin-Producing Islets Through Cell Editing

A hallmark of type 1 diabetes is the destruction of insulin-producing beta cells in the pancreas. These cells are crucial for producing and releasing insulin in response to rising blood glucose levels. Without them, glucose levels go unregulated and can become potentially fatal. Individuals with type 1 diabetes must be vigilant about testing their own blood sugar and administering insulin via syringe or an insulin pump as necessary.

However, a recent study aims to transform diabetes management in children with type 1 diabetes by using cell editing to produce healthy, functioning T cells that would intervene in the destruction of insulin-producing beta cells. Effector T cells and regulatory T cells (Treg) work together to balance the body’s immune response. When effector T cells attack, regulatory T cells keep them in check and limit the damage. But in individuals with type 1 diabetes, regulatory T cells do not function normally.

Researchers at Seattle Children’s Research Institute’s Center for Immunity and Immunotherapies and the Benaroya Research Institute at Virginia Mason (BRI) have discovered a way to edit patients’ T cells so that they function like regulatory T cells and protect pancreatic islet cells. Through gene editing, they turned on the FOXP3 gene in the cells and attached a T-cell receptor to make them antigen-specific to pancreatic cells.

According to Dr. Jane Buckner, president of BRI and co-investigator of the study, “We want to identify T-cell receptors that will create engineered Treg that will go on to and protect the pancreas. This type of therapy could then be used to stop the destruction of cells that produce insulin in the pancreas to slow the progression and ultimately prevent type 1 diabetes.”

The team recently received additional funding and is moving toward gaining approval to start a first-in-human clinical trial at Seattle Children’s. There are currently no other laboratories in the world conducting this same type of experimental therapy. The engineered cells have been tested in animal models and tissue cultures with positive results, but this would be the first human testing.

Diabetes Research Connection (DRC), though not involved in this study, is excited to see how the study advances and if human clinical trials are approved. This could be a major step forward in treatment and prevention options when it comes to type 1 diabetes. The DRC is committed to supporting these types of efforts and provides critical funding to early-career scientists pursuing novel, peer-reviewed research around type 1 diabetes. To contribute to these efforts and learn more about current studies, visit http://diabetesresearchconnection.org.

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Research Study for type 1 diabetes

Proactively Identifying Type 1 Diabetes

Identifying Type 1 Diabetes Development

Type 1 diabetes develops when the body mistakenly attacks and destroys insulin-producing beta cells. As the number of cells depletes, the body is unable to adequately control blood sugar levels. Researchers have been striving to find a way to prevent this destruction from occurring or to find a way to replace these cells so that the body can once again manage its own blood sugar.

A recent study took a closer look at exactly when this transformation begins to take place and beta cells begin dying off. They found that in many participants, the decline started at least six months prior to when patients would meet clinical requirements for a type 1 diabetes diagnosis. Diagnostic thresholds are currently a “fasting glucose of ≥126 mg/mL or 2-hour glucose of ≥200 mg/dL.”

The study involved 80 patients split into three categories: younger than age 11, ages 11 to 20, and older than age 20. All participants were first- or second-degree relatives of someone with type 1 diabetes and were diagnosed themselves while undergoing oral glucose tolerance tests (OGTTs) every six months. The results showed that across all age groups, C-peptide levels started declining around 12 months before diagnosis but showed the most significant changes in function in the 6 months prior to and 12 months following diagnosis.

By tracking these changes in individuals who are considered at-risk of developing type 1 diabetes, doctors may be able to catch declining beta-cell function early on and intervene with treatment before patients reach diagnostic thresholds for the disease. This could potentially be a way to prevent or slow the onset of type 1 diabetes through proactive immunotherapy.

More research is needed to further explore these findings and expand them to a larger group of participants. However, it provides researchers with insight on when type 1 diabetes may begin to develop and some changes to focus on. Diabetes Research Connection (DRC), though not involved with this study, supports early-career scientists in pursuing novel research studies around type 1 diabetes to help advance prevention and treatment efforts as well as minimizing complications, improving quality of life, and finding a cure. Learn more about current studies and how to support these projects by visiting https://diabetesresearchconnection.org.

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Medical Technology

Helping Drive Technology Advancements

Diabetes Patients Are Helping Drive Technology Advancements

Managing type 1 diabetes is an around-the-clock job. Patients must always be aware of what their blood sugar level is, whether it is trending up or down, whether or not to administer insulin, and if they do need insulin, how much. While there have been many advancements in technology to help with monitoring and insulin administration, the development and approval process is often long and drawn out. There are a limited number of devices approved by the government for use.

Patients with type 1 diabetes have begun taking their health into their own hands and improving treatment options. There are free directions online for how patients can connect their continuous glucose monitor (CGM) and their insulin pump with their smartphone to create a closed-loop system that tracks their blood glucose and automatically administers insulin as necessary. This type of artificial pancreas is something that researchers and pharmaceutical companies have been working on for years, but to date, there is only one commercially available closed-loop system available for use in Canada.

Jonathan Garfinkel, a Ph.D. candidate in the Faculty of Arts at the University of Alberta, took his chances and used the patient-created instructions for setting up the closed-loop system two years ago, and it has been life-changing. Previously, he was having a lot of difficulty managing his blood sugar overnight, and it would drop dangerously low. With the closed-loop system, his blood sugar has become much stabler overnight, and he is not tasked with regularly doing finger pricks and figuring out insulin dosing on his own.

These advancements in technology that patients with diabetes are developing have prompted pharmaceutical companies to quicken their own pace when it comes to getting devices created and approved for commercial use. Patients are becoming increasingly more comfortable with technology and relying on smartphones, sensors, and other devices to help them stay abreast of their health.

Garfinkel himself is also working on a project to advance technology for diabetes treatment. He is in the process of developing “a more affordable glucose sensor that would sit on top of the skin, rather than being inserted subcutaneously.” It was a project he began in collaboration with Mojgan Daneshmand, an engineer and Canada Research Chair in Radio Frequency Microsystems for Communication and Sensing, who was unfortunately killed in a plane crash in January 2020. Garfinkel is continuing the work that they started together and was awarded a U of A seed grant to help.

There are so many young researchers with incredible potential who can benefit from funding that will allow them to carry out their plans and see the results. The Diabetes Research Connection provides up to $50K in funding to early-career scientists to empower them in moving forward with their novel research projects focused on type 1 diabetes. These opportunities open doors to improving the prevention, treatment, and management of type 1 diabetes, as well as improving quality of life, minimizing complications, and one day finding a cure. Learn more by visiting https://diabetesresearchconnection.org.

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Sleep Disturbances with Type 1 Diabetes

Sleep Disturbances Common with T1D

Type 1 diabetes is a disease that must be monitored around the clock. When children are awake, it is easier to tell when blood sugar may be spiking too high or dropping too low. At night, this is more challenging, and it is essential to continue testing blood sugar levels to stay within the target range and administer insulin as necessary.

Children typically rely on their parents to manage their diabetes and monitor blood sugar, whether done manually or through a continuous glucose monitor (CGM). A recent study found that children who use a CGM often sleep better at night, but it is their parents who have more disturbances in their sleep due to reacting to CGM data.

As part of a larger study, researchers evaluated the sleep quality of 46 parents of children with type 1 diabetes. The children were between the ages of 2 and 5, and some used CGMs while others did not. Parents reported on the time their children went to bed, woke up, and how long they slept. The average was 10.4 hours per night. Also, all 11 families who used CGMs wore accelerometers that tracked their sleep patterns for a minimum of four nights. The accelerometer showed an average of 9.8 hours of sleep per night for children.

According to the study, “Among the full cohort, 63% of parents reported checking their child’s blood glucose levels at least a few nights per week. Parents of children using CGMs reported a higher frequency of nighttime blood glucose monitoring compared with parents of children without a CGM.”

The percentage of parents who experienced sleep disturbances concerning blood glucose monitoring was noticeably higher than the percentage of children, at 78.3% and 17% respectively. Parents of children with CGMs reported higher levels of sleep disturbance, especially when the child’s diabetes was more difficult to manage. Additional research with a larger group of participants across a longer period of time is necessary to better understand the impact of diabetes management on sleep for parents and children.

It is important for physicians to keep in mind not just the impact a CGM or other device could have on the child’s health and quality of life, but also on the parent. Parents benefit from having proper support systems in place and information to help them cope with the challenges of managing their child’s type 1 diabetes.

Diabetes Research Connection, though not involved in this study, is committed to supporting early-career scientists focused on studying type 1 diabetes and ways to improve prevention, treatment, and quality of life, as well as one day finding a cure. One hundred percent of donations go directly to the scientists for their research. To learn more about current projects and how to help, visit https://diabetesresearchconnection.org.

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Enhancing Protection for Islets

Enhancing Protection for Islets Following Transplantation

One treatment approach for type 1 diabetes that researchers have been experimenting with and refining for more than 20 years is islet transplantation. The goal is to take insulin-producing islets from cadavers (or another source) and transplant them into individuals with type 1 diabetes so that these cells will thrive and allow the body to begin producing insulin once again.

A common challenge with this approach is protecting the cells from immune system attack or cell death from lack of oxygen. A recent study has found a way to overcome some of these obstacles by encapsulating the islets in a jelly-like substance made of collagen. This helps create a scaffolding that will not initiate an immune response yet contains the islets while allowing them to grow new blood vessels that will ultimately provide them with oxygen. Since this blood vessel regrowth can take time, the researchers also injected the scaffolding with calcium peroxide. As the calcium peroxide breaks down, it releases oxygen which is used to keep the cells alive as they settle in and begin working.

In traditional organ transplantation, the organ is surgically connected to the circulatory system meaning that the organ automatically begins receiving the oxygen and nutrients it needs for survival. Islet transplants do not work this way since the cells are not a solid organ. In addition, the cells are typically injected into the liver rather than the pancreas where they would normally occur. There is a greater risk of the pancreas having a negative reaction and destroying the islets than the liver.

The researchers tested this new bioscaffold in diabetic mice. Some mice received islets on their own, some received islets in the bioscaffold, and some received islets and calcium peroxide in the bioscaffold. The diabetic mice who received the islets and calcium peroxide demonstrated greater blood glucose control over four weeks than the other two groups. The team is now looking at the possibility of injecting the scaffolding with stem cells as well to further enhance islet survival and function.

These types of advancements in treatment are encouraging when it comes to type 1 diabetes. It is expected that the U.S. Food and Drug Administration (FDA) will approve islet transplantation as a valid treatment for T1D, rather than an experimental treatment, this year. This could increase the number of options available to patients for effectively managing the disease.

Diabetes Research Connection continues to stay abreast of changes in the field and provides critical funding for early-career scientists pursuing novel research around T1D. Learn more about current projects and how to support these efforts by visiting https://diabetesresearchconnection.org.

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Reduced Out-of-Pocket Insulin Costs for Seniors Through Medicare

Out-of-Pocket Insulin Costs for Seniors

The cost of buying insulin can quickly add up, but this medication is life-sustaining for individuals with type 1 diabetes. Many seniors are on a fixed income, and some may struggle to afford the out-of-pocket costs for insulin, which can lead to rationing their supply. This can be incredibly dangerous to their health.

The Centers for Medicare & Medicaid Services (CMS) recently announced that it would implement measures to help curb these costs for seniors. Many Medicare Part D prescription drug plans and Medicare Advantage plans with prescription drug coverage will now be offering lower insulin costs to seniors, capping the copay at $35 for a month’s supply. This is part of the new Part D Senior Savings Model and will cover “both pen and vial dosage forms for rapid-acting, short-acting, intermediate-acting, and long-acting insulins.”

Insulin manufacturers and Part D sponsors are working together to offer this market-based solution that enables them to provide deeper discounts to seniors and fixed, predictable copays in the coverage gap. According to CMS, “beneficiaries who use insulin and join a plan participating in the model could see an average out-of-pocket savings of $446, or 66 percent, for their insulins, funded in part by manufacturers paying an estimated additional $250 million of discounts over the five years of the model.”

Seniors will be able to go on to the CMS website and compare their prescription drug plan options to find a participating sponsor and plan that fits their needs. Enrollment would begin in the fall for coverage starting on January 1, 2021. There have also been numerous actions that have been taken in response to COVID-19 to support individuals with type 1 diabetes in accessing and affording insulin.

It is encouraging to see drug manufacturers and insurance companies making changes to improve access and affordability of life-sustaining medications such as insulin. Diabetes Research Connection (DRC) will continue to stay abreast of these trends and how they impact diabetes management. DRC provides critical funding for researchers focused on type 1 diabetes to find a cure and improve prevention and treatment options as well as the quality of life. To learn more, visit https://diabetesresearchconnection.org.

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Preserving Endogenous Insulin Production

Preserving Endogenous Insulin Production in Newly Diagnosed Type 1 Diabetes Patients

A hallmark of type 1 diabetes is the body loses its ability to naturally produce enough (or any) insulin to effectively manage blood glucose levels. This is due to the mistaken destruction of insulin-producing beta cells by the immune system, a process that researchers are continually learning more about. In many cases, when type 1 diabetes (T1D) is first diagnosed, there is a short window of time (up to about six months) where the body still creates insulin, but not enough to meet demand.

A recent study explored a new way to try to preserve endogenous insulin production and reduce the amount of insulin newly diagnosed patients required. The study involved 84 patients ages 6 to 21 who had been diagnosed with T1D within 100 days of the start of the trial. Approximately two-thirds of participants were given the drug golimumab, while the other one-third received a placebo. Golimumab is an anti-tumor-necrosis-factor (TNF) therapy that is already approved by the Food and Drug Administration (FDA) for the treatment of rheumatoid arthritis, ulcerative colitis, and other autoimmune conditions. It has not yet been approved for use in patients with T1D.

The patients who received golimumab self-administered the drug via injection every two weeks. Results showed that these patients achieved markedly better glycemic control that patients receiving the placebo. After 52 weeks of treatment, “41.4% of participants receiving golimumab had an increase or less than 5% decrease in C-peptide compared to only 10.7% in the placebo group.”

Furthermore, patients who were still in the “honeymoon phase” of their diabetes, or the first 3-6 months after diagnosis where there is still some endogenous insulin production and not as much injected insulin is needed, also showed improvement once transitioning out this phase and continuing to take golimumab. Those patients showed a smaller increase in injected insulin than the placebo group requiring just 0.07 units per kilogram more per day versus 0.24 units per kilogram per day respectively. Another notable improvement is that patients between the ages of 6 and 18 experienced 36% fewer episodes of level 2 hypoglycemia, a condition that can be potentially life-threatening and negatively impact the quality of life.

Since golimumab is already FDA-approved for other conditions, these phase 2 study results play an important role in moving the process forward to show that it may be an effective treatment for T1D as well. This therapy may be able to help newly diagnosed patients retain some of their body’s natural insulin-producing abilities and decrease the amount of injected insulin needed to maintain good glycemic control.

Golimumab may become another option for patients with type 1 diabetes in the future and change how the disease is managed when caught and treated early on. It is encouraging to see new ways to preserve beta-cell function. Diabetes Research Connection (DRC) is interested to see how this study unfolds and whether golimumab is approved for the treatment of type 1 diabetes.

Although not involved in this study, DRC supports early-career scientists in pursuing studies like these and other projects related to preventing and curing T1D as well as minimizing complications and improving the quality of life for individuals living with the disease. Scientists can receive up to $50K in funding to advance their research. To learn more about current projects and support these efforts, visit https://diabetesresearchconnection.org.

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Examining Pancreatic Beta Cell Regeneration Processes

Researchers often use cell cultures and tissue slices to study the function and processes of various cells. One of the challenges of this approach, however, is the viability of these samples. For instance, pancreatic tissue slices typically show significant cell death after less than 24 hours due to poor oxygenation. This means that only short-term studies are possible, using samples while they are most viable and representative of the integrity of the native organ.

But, researchers are looking to change that. In a recent study, scientists altered how human pancreatic slices (HPSs) are cultured and managed to preserve function for 10 days or more. This is significant when it comes to being able to conduct longer-term longitudinal studies. Studies were also conducted on tissue samples from non-transgenic mice.

Traditionally, HPSs are preserved in standard transwell dishes. In this model, tissue is placed on top of a liquid-permeable membrane and surrounded with an air-liquid medium. However, oxygenation begins to decrease within several hours, and signs of anoxia appear. A new approach uses perfluorocarbon (PFC)-based dishes. This model places tissue atop a liquid-impermeable membrane providing direct contact with oxygen. An air-liquid medium also surrounds the slice. A variety of testing shows that PFC-based cultures have improved oxygenation and lower levels of anoxia.

In turn, this allowed scientists to more effectively study pancreatic beta-cell regeneration processes. HPSs retain “near-intact cytoarchitecture” of the organ in its native state in the body. Combined with the longer-term viability of the samples in the PFC-based setting, researchers were able to focus in on how and where beta cells were regenerating. They used HPSs from non-diabetic individuals as well as those with type 2 diabetes to enhance their understanding of how to stimulate this regeneration and improve insulin production.

When samples were left to rest for 24 hours to reduce the impact of stress from slicing and then treated with Bone morphogenetic protein 7 (BMP-7) proteins, scientists found that they showed higher levels of beta-cell regeneration than controls that were not treated with BMP-7. Much of this cell development occurred in regions corresponding to pancreatic ducts. Some new cells emerged from existing beta cells, while others transitioned from alpha to beta cells.

Improved oxygenation methods are changing how scientists are able to interact with HPSs and the types of testing they are able to conduct. According to the study, “Our goal in refining the conditions for the long-term survival of HPS was to allow for the real-time detection and quantification of endocrine cell regeneration.” While more in-depth and extensive studies are needed, these findings may lead the way toward improved understanding of the pathology of pancreatic beta-cell regeneration and new treatment options for individuals with type 1 diabetes.

Diabetes Research Connection (DRC) is committed to supporting these types of advancements and efforts by providing critical funding to early-career scientists pursuing novel, peer-reviewed research related to type 1 diabetes. With adequate funding, scientists are able to bring their ideas to life and contribute to not only greater understanding of the disease, but improved methods and therapies for diagnosing, treating, managing, and eventually curing type 1 diabetes. Learn more about current projects and support these efforts by visiting https://diabetesresearchconnection.org.

 

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Could Insulin Management be Controlled with an App?

Determining the appropriate amount of insulin to administer in response to drops in blood sugar can be challenging, but it is something that individuals with type 1 diabetes must do daily in order to manage their health. If left untreated, low blood sugar (or hypoglycemia) can be potentially fatal.

A team of researchers and physicians at Oregon Health & Science University (OHSU) are looking to improve diabetes management through a new app called DailyDose. While there are similar types of apps that exist, what sets DailyDose apart is that has demonstrated statistically relevant outcomes through multiple clinical studies. The AI algorithm for the app was originally developed entirely through a mathematical simulator, but when real-world data was used, the recommendations generated by the app aligned with recommendations provided by physicians, or were still considered safe, more than 99% of the time. In addition, improved glucose control was achieved. This was determined after 100 weeks of testing conducted in four-week trials.

Each trial involved 16 patients with type 1 diabetes and combined information from a continuous glucose monitor or wireless insulin pen with the app. Nearly 68% of the time, the recommendations generated agreed with those of physicians.

These findings are important because they show that the app may be effective in supporting individuals with type 1 diabetes in reducing risk of hypoglycemia by better managing insulin administration and blood glucose levels between appointments with their endocrinologist. Larger clinical trials are needed over longer periods of time to further determine the accuracy and effectiveness of the app in relation to other treatment strategies.

Technology is becoming increasingly more popular and advanced in terms of managing type 1 diabetes. There are numerous devices and apps already available and more in the works. This gives individuals with type 1 diabetes a wider variety of options in order to determine what works best for their needs and lifestyle.

Though not involved with this study, the Diabetes Research Connection (DRC) strives to continue growing understanding of type 1 diabetes and improving prevention and treatment methods as well as one day finding a cure. Early-career scientists can receive critical funding through the DRC to pursue novel research studies around T1D. Learn more about current projects and how to support these efforts at http://diabetesresearchconnection.org.

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Could Advancements in Gene Editing Reverse Type 1 Diabetes?

Gene therapy is not a new approach when it comes to treating type 1 diabetes. Scientists have been experimenting with many different options in order to stimulate the body to once again produce its own insulin and reduce or eliminate the need for insulin injections. However, some of the problems that scientists often encounter when introducing new cells into the body are that patients typically require immunosuppressant drugs which can lead to a variety of complications, the body rejects the cells over time, or the cells stop working. Finding a long-term, effective solution has been challenging.

Scientists are making strides in their efforts, though. A recent study examined the potential of using the gene-editing tool CRISPR to correct genetic mutations and create induced pluripotent stem cells that can be transformed into pancreatic beta cells. In mouse models, after the new cells were injected, mice achieved normoglycemia within a week and maintained this status for at least six months.

This approach has not yet been tested in humans, however, because it comes with its own set of challenges. First, the study was done using cells from patients with Wolfram syndrome, a condition that causes diabetes and deafness. This condition can be pinpointed to a single genetic mutation, whereas type 1 diabetes cannot. Type 1 diabetes has been tied to multiple gene mutations, as well as environmental factors. Gene-editing would have to be personalized for each individual, which could take a lot of time.

In addition, it could take billions of cells to effectively reverse diabetes in a patient, and generating this massive number of cells could take months, so it could end up being a long process to treat even one person. Plus, scientists are not entirely sure where the best place to transplant these cells is yet. They must find the spot where they will be most beneficial and able to carry out their intended purpose.

Another study using CRISPR technology is being conducted by a different group of researchers and is focused on using stem cells from the human cell line rather than from individual patients. This would make it easier to produce mass quantities of cells in a shorter period of time. It also would not require scientists to correct specific genetic mutations. CRISPR would be used to edit cells to prevent them from being attacked and destroyed by the body’s immune system.

A challenge with these approaches is that there are a lot of questions and regulations when it comes to gene-editing and using CRISPR on human subjects. Clinical trials are still in very early stages. Studies involving induced pluripotent stem cells are also relatively new in the United States. There is still a lot of work, research, and testing that needs to be done before gene-editing therapy could potentially be used on humans.

Diabetes Research Connection (DRC) will continue to follow these advancements and what they could mean for future diabetes treatment. DRC supports early-career scientists in contributing valuable discoveries and information of their own to the field by providing critical research funding. All projects funded by the DRC are focused on the prevention, treatment, and cure of type 1 diabetes, as well as minimizing complications and improving the quality of life for individuals living with the disease. Learn more and support these efforts by visiting https://diabetesresearchconnection.org.

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Exploring the Impact of Type 1 Diabetes on COVID-19

For the past several months, the world has been struggling to contain the spread of COVID-19 and effectively treat patients diagnosed with this disease. It is a new strain of coronavirus that researchers continue to learn more about every day. One thing that is known about the virus is that individuals with underlying health conditions are at increased risk of developing severe illness and complications.

One such underlying health condition that researchers are paying closer attention to is type 1 diabetes (T1D). Preliminary research from small studies appear to show that individuals with T1D are at increased risk of poorer health outcomes than those with type 2 diabetes (T2D) or no history of diabetes. A recent study of 64 individuals with T1D and confirmed or suspected COVID-19 in the United States found that “more than 50% of all cases reported hyperglycemia, and nearly one-third of patients experienced DKA.” Both hyperglycemia and diabetic ketoacidosis (DKA) can be life-threatening conditions if not properly treated in time.

Furthermore, research released from the United Kingdom’s National Health Service (NHS) revealed that hospitalized individuals with T1D are significantly more likely to die from COVID-19 than those with T2D. Scientists believe that hyperglycemia may enhance the immune system’s overresponse thereby exacerbating the impact of severe infections.

Being hospitalized can make it more difficult for individuals with T1D to maintain glycemic control because their body is already trying to fight off infection, and they may not have the mental clarity or ability to effectively monitor their own blood sugar. Diabetes Research Connection (DRC) sponsored a study by Addie Fortmann, Ph.D., regarding the use of continuous glucose monitors (CGMs) in hospital settings, which found that these devices were pivotal to glycemic control. As a result, Scripps deployed this technology across all of their hospitals to better support diabetes management.

But not every hospital in the United States allows patients to use their CGM while admitted, and not all staff is adequately trained in diabetes care. This can complicate things for patients struggling with T1D as well as COVID-19 and contribute to poorer health outcomes. Not only are patients fighting against the effects of COVID-19 including fever, shortness of breath, dry cough, nausea, body aches, and fatigue, if their blood sugar should go too high or too low, this can add to more symptoms and complications. In both patients with confirmed and suspected COVID-19 as well as T1D, DKA was the most prevalent adverse outcome.

It is essential that attention is given to managing underlying conditions such as diabetes in order to provide more effective treatment tailored to patient needs. Since 2012, the DRC has been providing critical funding for early-career scientists pursuing novel, peer-reviewed research related to type 1 diabetes. This work is essential to advancing understanding of the disease, improving prevention strategies and treatment options, minimizing complications, enhancing quality of life, and working toward a cure. Learn more about current projects and how to support these efforts by visiting https://diabetesresearchconnection.org.

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Taking Steps to Prevent Diabetic Ketoacidosis in Pediatric Patients with Type 1 Diabetes

There are many complications that can occur with type 1 diabetes, but one of the most serious is diabetic ketoacidosis (DKA). When the body does not produce (or have) enough insulin to help convert sugar to energy, it begins breaking down fat and using that as fuel instead. However, this releases acid known as ketones into the bloodstream, in turn leading to DKA when levels become too high.

A recent study found that DKA among newly diagnosed pediatric patients with type 1 diabetes is alarmingly high among patients around the world. During an 11-year study spanning from 2006 to 2016, researchers found that out of 59,000 children who had been diagnosed with T1D, 29.9% presented with DKA at diagnosis. The study examined data from children in Austria, the Czech Republic, Germany, Italy, Luxembourg, Norway, Slovenia, Sweden, Wales, Australia, New Zealand, and the United States.

Of these countries, prevalence rates in Luxembourg and Italy were found to be the highest at 43.8% and 41.2%, respectively, while Sweden and Denmark had the lowest rates at 19.5% and 20.8%, respectively. DKA at diabetes diagnosed increased over the 11-year study in the United States, Australia, and Germany. Overall, DKA tended to impact a higher proportion of females than males, except in Wales.

In order to help reduce risk of DKA at diagnosis, the researchers encourage improved screenings beginning with young children. For example, Bavaria, Germany tests for islet autoantibodies as part of a public health screening for children between the ages of 2 and 5. Studies showed that their prevalence of DKA at diagnosis came in at less than 5%. Increased screenings and education may be beneficial in raising awareness and catching potential problems early on before DKA develops.

Though not involved with this study, the Diabetes Research Connection (DRC) is committed to improving understanding, prevention, and treatment of type 1 diabetes by providing critical funding for novel, peer-reviewed research studies by early-career scientists. Find out how to support these efforts and learn more about current projects by visiting https://diabetesresearchconnection.org.

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Managing Blood Sugar During Exercise with Long-Acting Insulin

Engaging in regular physical activity is good for overall health. It helps with weight management, blood pressure, cardiovascular health, blood sugar, and more. Individuals with type 1 diabetes may find exercise helpful in improving insulin sensitivity and reducing the amount of insulin needed following activity. However, this can also be a challenge because they must carefully monitor their blood-glucose levels to ensure that they do not become too low or too high.

A recent study found that combining long-acting insulin (degludec) with the use of an insulin pump can be beneficial for managing glucose levels during and after exercise. Some individuals with T1D prefer to remove their insulin pump during exercise, and by administering degludec before starting exercise, they were able to remain in target range (70-180 mg/dL) for longer periods of time than when just using the insulin pump alone.

The study involved 24 physically active adults who participated in two phases of workouts that included five weeks of high- and moderate-intensity sessions. During one phase, they only used their insulin pump to control their basal insulin needs, and for the second, they used the insulin pump and the degludec. When using the insulin pump alone, they spent an average of 143 minutes (40% of the time) in target range, but when using the degludec, this time in range increased to 230 minutes (64% of the time).

The researchers found that “this was down to a significant 87-minute reduction in time spent in hyperglycemia, with no difference seen for hypoglycemia” as well. In addition, when using the hybrid insulin approach, blood sugar rose just 14.5 mg/dL after 30 minutes following exercise, compared to an 82.9 mg/dL increase using the insulin pump alone.

More than two-thirds of participants found the hybrid insulin regimen useful, and nearly half said they were somewhat or very likely to continue using this approach while exercising in the future. The researchers are looking at moving forward with a larger study to see if these results continue to be significant when more people are involved.

This study shows that there may be more than one effective option for improving glucose control during exercise for individuals with type 1 diabetes. They do not have to rely on the insulin pump alone, and some may find administering degludec beneficial when exercising without their insulin pump.

Diabetes Research Connection (DRC) is interested to see how this study plays out in the future and if more people can benefit from the hybrid insulin regimen while exercising. It is encouraging to see more options become available to help individuals better control their diabetes while improving their health and quality of life. DRC supports early-career scientists in pursuing novel research on type 1 diabetes by providing access to funding. The goal is to one day find a cure while also improving prevention, treatment, and management of the disease. Learn more by visiting http://diabetesresearchconnection.org.

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Could Benefits of Early Screening for Type 1 Diabetes Outweigh Costs?

Advances in science have improved the ability to identify warning signs for type 1 diabetes (T1D) early on. For instance, scientists can detect the destruction of insulin-producing beta cells before noticeable signs of diabetes emerge or conditions such as diabetic ketoacidosis (DKA) occur. They have also determined other key changes and factors that may put an individual at increased risk.

A recent study found that conducting health screenings on children can increase awareness regarding their risk of developing T1D, help prevent DKA occurrences, and encourage individuals to take better care of their health to reduce complications and impact of the disease.

Researchers at the Barbara Davis Center for Diabetes at the University of Colorado School of Medicine created the Autoimmunity Screening for Kids (ASK) study to determine if this type of health screening is beneficial. While it can be costly to conduct widespread screenings for children between the ages of 1 and 17, they found that there are a host of benefits such as those mentioned above. In addition, the long-term cost savings can quickly make up for screening expenses because when individuals know their risk and learn how to better manage their T1D, it can reduce complications and associated healthcare costs.

Now they are looking at how to effectively implement screenings, what the practice would look like, what the age schedule for screenings should be, and who would benefit most. Early detection can play an integral role in managing T1D and improving quality (and quantity) of life.

Diabetes research occurs at all stages of the disease, from the time patients are pre-symptomatic to those with the most serious complications. It covers everything from screenings to closed-loop systems for treatment to understanding the cellular and molecular impact of the disease. Diabetes Research Connection is committed to supporting a wide range of T1D research by providing critical funding to early-career scientists. Learn more about current projects and how to help by visiting https://diabetesresearchconnection.org.

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Study Affirms Safety and Effectiveness of U.S. Insulin Products

When an individual with type 1 diabetes (T1D) administers insulin to control their blood sugar levels, they want to feel confident that no matter what U.S. retail pharmacy they purchased their insulin from, it will work. Differences in consistency and potency of insulin could have a detrimental impact on patient health and their ability to manage their T1D.

A recent study looked at samples of human and analog insulin products from across manufacturers and found that they were all correctly labeled and contained the expected quantity of active insulin. Since individuals with T1D rely on insulin injections multiple times per day, it can be reassuring to know that the product they are using adheres to how it is labeled.

The study was a joint effort between JDRF, the American Diabetes Association (ADA), and the Leona M. and Harry B. Helmsley Charitable Trust. The study was conducted within a single year, so now the team is looking to expand to a second phase that measures for any variations again, this time looking at “potential seasonal variations in reported insulin activity.”

Diabetes Research Connection (DRC) is proud to see that manufacturers are producing quality insulin products that meet consistency and potency standards. Worrying about the quality of their insulin is not something that individuals with T1D should have to do. The DRC supports early-career scientists in pursuing novel, peer-reviewed research focused on the prevention and cure of type 1 diabetes as well as minimizing complications and improving quality of life for individuals living with the disease. To learn more, visit https://diabetesresearchconnection.org.

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Combination Therapy May Help Improve Blood Sugar Management

Maintaining stable blood sugar levels and minimizing complications is a constant challenge for many individuals living with type 1 diabetes. They must always be alert to whether their blood sugar is too low or too high and how much insulin to administer. However, researchers are continually exploring ways to improve blood sugar management by better understanding how diabetes affects the body.

In a recent study, researchers from Stanford University have taken a new approach by combining two FDA-approved drugs and developing a way for them to work in tandem as they naturally do in the body through a single injection. In addition to insulin, individuals with type 1 diabetes (T1D) would also take a drug based on the hormone amylin. This drug is already FDA-approved, but less than 1% of patients with diabetes take it. This could be because they do not want to administer a second shot every time they take insulin. When combined, insulin and the amylin-based drug work together just as they do when naturally occurring in the body. Amylin is produced by the same insulin-producing beta cells in the pancreas.

According to researchers, amylin works in three ways:

“First, it stops another hormone, glucagon, from telling the body to release additional sugar that has been stored in the liver. Second, it produces a sense of “fullness” at mealtimes that reduces food intake. Third, it actually slows the uptake of food by the body, reducing the typical spike in blood sugar after a meal. All three are a boon to diabetes care.”

However, in their current states, insulin and the amylin-based drug are too unstable to combine in one syringe. To combat this problem, the researchers have developed a protective coating that encompasses each molecule individually, allowing them to stably exist together. This molecular wrapper has a Velcro-like feature that “reversibly binds to both insulin and amylin separately, shielding the unstable portion of each molecule from breakdown.” Once administered, the coating dissolves in the bloodstream.

With this protective coating – known as cucurbituril-polyethylene glycol (CB-PEG) – the combination of insulin and the amylin-based drug showed stability for at least 100 hours. This could give it a shelf life that is long enough to be used with an insulin pump. Researchers have tested the combination therapy on diabetic pigs and are working toward gaining approval for human trials. Since both drugs are already FDA-approved, this could help to move things along more quickly.

Diabetes Research Connection (DRC) is excited to see what this could mean for the future of T1D treatment and blood glucose management. This combination therapy could help alleviate some of the challenges that patients face and improve management of the disease. Though not involved with this study, the DRC is committed to supporting research around type 1 diabetes in order to improve diagnosis, treatment, prevention, and the pursuit of a cure. The organization provides critical funding to early-career scientists to advance their research. Learn more about current projects and how to support these efforts by visiting https://diabetesresearchconnection.org.

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Glucose-Sensing Neurons Work Together to Manage Blood Sugar

Whereas insulin is necessary to combat high blood glucose levels, a different hormone is necessary to manage low ones: glucagon. This hormone helps to regulate glucose production and absorption bringing glucose levels back into an acceptable range.

A recent study from researchers at Baylor University and other institutions found that there is a specific group of neurons in the brain that may play an integral role in blood sugar regulation and preventing hypoglycemia. Within the ventrolateral subdivision of the ventromedial hypothalamic nucleus region, there are estrogen receptor-alpha neurons that are also glucose-sensing.

What the researchers found particularly interesting was that half the neurons became more active when blood sugar levels were high (glucose-excited), and the other half became more active when blood sugar levels were low (glucose-inhibited). Furthermore, each group of neurons used a different ion channel to regulate neuronal firing activities. However, they both led to the same result – increasing blood glucose levels when they were low – even though they were activating different circuits in the brain. This leads to a perfect balance in managing blood sugar.

The next step in the study is to investigate whether the fact that all of the neurons in this specific group that expressed estrogen receptors play a role in the glucose-sensing process. In turn, this could lead to more gender-specific studies to determine differences in neuronal function when it comes to blood sugar regulation.

One important factor to note is that all of these studies were conducted on hypoglycemic mice. The researchers did not identify whether the process is believed to be the same in humans.

This is another step forward in better understanding how diabetes affects the body, brain, and functioning. Diabetes Research Connection strives to empower early-career scientists in pursuing novel, peer-reviewed studies related to type 1 diabetes by providing up to $50K in funding. Research is focused on the prevention and cure of type 1 diabetes as well as minimizing complications and improving quality of life for individuals living with the disease. Find out how to support these efforts by visiting https://diabetesresearchconnection.org.

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Targeting the Effects of Specific Drugs on Pancreatic Islets

The production of insulin and glucagon used to regulate blood sugar levels come from pancreatic islet cells. In individuals with type 1 diabetes, the immune system mistakenly attacks and destroys these cells leaving the body unable to naturally regulate blood sugar. That means that individuals must continuously monitor and manage these levels themselves.

A recent study examined the impact that specific drugs have on pancreatic islet cells and their function. Researchers were able to fine-tune single-cell transcriptomics to remove contamination from RNA molecules that could interfere with results and negatively affect reliability of the data.

Once they had created decontaminated transcriptomes, they tested three different drugs that relate to blood glucose management. They found that one drug, FOXO1, “induces dedifferentiation of both alpha and beta cells,” while the drug artemether “had been found to diminish the function of alpha cells and could induce insulin production in both in vivo and in vitro studies.” They compared these drugs in both human and mouse samples to determine if there were any differences in how the cells responded. One notable difference was that artemether did not have a significant impact on insulin expression in human cells, but in mouse cells, there was reduced insulin expression and overall beta cell identity.

Single-cell analysis of various drugs could help guide future therapeutic treatments for type 1 diabetes as researchers better understand their impact. Targeted therapies have become a greater focus of research as scientists continue to explore T1D at a cellular level.

Diabetes Research Connection (DRC) is interested to see how single-cell sequencing and the ability to decontaminate RNA sequences could affect diabetes research. The organization supports a wide array of T1D-focused studies by providing critical funding to allow early-career scientists to advance their research. To learn more and support these efforts, visit https://diabetesresearchconnection.org.

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Examining the Co-Occurrence of Asthma and Type 1 Diabetes

It is not uncommon for individuals to have more than one disease or condition at a time. Oftentimes, there is an underlying link between their development, even if it is not entirely understood. In addition, many conditions run in families, which can be due to genetics or even possibly environmental factors.

A recent study looked at data from more than 1.2 million children in Sweden to see if there was a potential association between asthma and type 1 diabetes. They examined risk both within individuals and within families, comparing information from full siblings, half-siblings (both maternal and paternal), full cousins, and half cousins as well.

According to their results, individuals with asthma were at increased risk of developing type 1 diabetes (T1D), but the presence of T1D did not increase their risk of later developing asthma. In addition, if an individual had either T1D or asthma, their full siblings were at increased risk of developing either disease. Full cousins were also at a greater risk.

Data was obtained from several Swedish registers held by the National Board of Health & Welfare and Statistics Sweden and encompassed 1,284,748 singleton children born in Sweden between January 1, 2001, and December 31, 2013. Of these children, 121,809 had asthma, 3,812 had T1D, and 494 had both diseases. Their findings suggest that there may be shared familiar factors that affect associations ranging from genetics to environment.

Understanding these potential associations may help healthcare providers with recognizing symptoms of either disease earlier on if one has already been diagnosed. It may also influence management or treatment of these diseases. More research is necessary to further explore possible connections between asthma and T1D and what that might mean for future care.

Though not involved in this study, the Diabetes Research Connection (DRC) is continually striving to advance research related to T1D by providing critical funding to early-career scientists for their studies. This can lead to improved diagnosis, treatment, and prevention methods, as well as one day finding a cure. To learn more about current research projects and how to help, visit https://diabetesresearchconnection.org.

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Using Saliva to Monitor Blood Glucose Levels

Traditional blood glucose monitoring for type 1 diabetes has involved using finger sticks to draw and test a small droplet of blood. This can leave fingers sore and calloused as testing occurs multiple times throughout the day to keep blood sugar in check. In addition, it requires a variety of supplies, and lancets used to draw blood must be disposed of safely and properly.

A recent study found that there may be a non-invasive method of monitoring blood sugar that is easier to collect and test: saliva. Researchers found that saliva contains numerous biomarkers that could make it a feasible alternative to blood. In addition, testing is conducted using Attenuated Total Reflectance Fourier Transform Infrared (ATR-FTIR) spectroscopy rather than the reagents that are necessary when blood is used. That makes saliva a more sustainable and eco-friendly option as well. In early testing, using saliva was 95.2% accurate in monitoring blood sugar.

Regular testing and monitoring of blood sugar is essential for individuals with type 1 diabetes to reduce risk of hypo- or hyperglycemia as well as diabetic ketoacidosis and other complications. However, many people do not enjoy constant finger sticks. Using saliva and ATR-FTIR spectroscopy or other technology could become a non-invasive, less painful option. This process is still in early stages of testing, and more research is needed to determine its efficacy and how exactly it could be used by patients.

Diabetes Research Connection (DRC) is excited to see how this form of blood glucose monitoring evolves moving forward and what it could mean for individuals living with type 1 diabetes. It is another step toward providing more management options and better meeting the needs of individuals with diabetes.

Though not involved with this study, the DRC is committed to providing critical funding for early-career scientists pursuing research related to type 1 diabetes. This could include topics focused on improved diagnosis, treatment, prevention, and management of the disease, as well as minimizing complications, enhancing quality of life, and finding a cure. To learn more and support these efforts, visit https://diabetesresearchconnection.org.

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Using Gene Editing as a Potential Type 1 Diabetes Treatment

It has been more than a decade since scientists began experimenting with CRISPR gene-editing technology to alter DNA sequences and gene function. This tool allows scientists to correct mutations or defects in genes and manipulate them to treat or prevent certain diseases. This technology has also been used with crops. Researchers are still exploring this tool’s potential and ethical use, but many studies have been conducted thus far using it in different ways.

A recent study examines the use of CRISPR-Cas9 in the treatment of diabetes. Scientists at Washington University in St. Louis corrected a mutation in the WFS1 gene which causes Wolfram syndrome, of which diabetes is one symptom. Then, they used CRISPR-Cas9 to edit human-induced pluripotent stem cells and target their differentiation into pancreatic beta cells. This creates an abundance of fully functional beta cells to be used in conjunction with gene therapy.

When the altered beta cells were transplanted into diabetic mice, blood glucose levels dropped and glycemic control was maintained for at least six months. Scientists are exploring whether this process can be used to effectively reverse or stop type 1 diabetes by editing a patient’s own beta cells. In addition, the abundance of cells created means that more testing can occur to develop specific medications or therapies to treat the disease.

More research is needed before gene editing can potentially be used as an approved treatment for type 1 diabetes, but researchers continue to learn more. Diabetes Research Connection (DRC) is interested to see what this technology may mean for the future of diabetes treatment and management and how it could evolve. Though not involved with this study, the DRC is committed to supporting research around type 1 diabetes and provides early-career scientists with critical funding for novel, peer-reviewed studies. To learn more about current projects and how to help, visit https://diabetesresearchconnection.org.

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